Prevalence of Intestinal Parasites Among Rural
Population in Babylon Province
Ahmed M. Al-Moussawi
College of Dentistry, University of Babylon
Abstract
An epidemiological study was conducted during the period
from May 2002 till February 2003 to investigate of the
prevalence of intestinal parasites among population at AlDoullab village ( Hilla city rural) Babylon province . A total of
681 faecal samples from different ages were examined. There
are many intestinal parasites were detected such as (10.5% for
Entamoeba coli , 10.1% for E. histolytica , 8.9 % for
Iodamoeba butchlii, 7.2% for Giardia lamblia , 2.9 % for
Trichomonas hominis, 4.1% for Blastocystis hominis , 0.8% for
Isospora belli, 7.6% for Hymenolepis nana, 6.0 % for
Enterobius vermicularis, 2.8 % for Ascaris lumbricoides ,1.5%
for Ancylostoma duodenale). The overall percentage incidence
of intestinal parasites infection in this study was 62.7 %.
Introduction
The parasitic infections in people regard as a major problem in
the world especially in the communities whom suffering from
poor sanitation and low personal hygiene such as primary
schools pupils and rural communities. (Garcia & Bruckner,
1993)
Intestinal parasites distributed in various ages equally in both
rural and civilian environments where the rural environment
provide normal conditions for presence of such infections as
general while the civilian environment provide a social
conditions for such infections (Hashem et al., 1999).
The number of studies deal with the prevalence of intestinal
parasites in Iraq is low relatively compared with the percentages
of parasite distribution (Hashem et al., 1999).
1
In Iraq there are many epidemiological studies of the parasites
infections, we review some of them.
In Naienawa province show the total percentage of the
intestinal parasites was (70%) where including (19.5%)
Entamoeba coli ,(3.11%) Entamoeba histolytica ,
(11.9%)Giardia lamblia , (19.5%) Hymenolepis nana , (11.8%)
Enterobius vermicularis , (2.95%) Ascaris lumbricoides and
(0.6%) Ancylostoma duodenale in addition to presence a
variation in basic blood component values ( hemoglobin amount
and eosinophile count ) in the infected and non infected
individuals (Al-Omar, 1992).
Al-Dulaimi (1996) conclude after his checking of 1086
stool specimens for intestinal parasites detection in Al-Anbar
city the total infection was (37.2%) including (9.3%) E
histolytica, (25.7%) G lamblia and (0.5%) H nana .
In field study for intestinal parasites infection among
Deiala city 6645 stool specimens were tested and reveal the total
infection was 29.1% and many intestinal parasites were
recorded such as E histolytica (13.6%) , E coli (1%), G
lamblia(11.1%), H nana(0.6%), E vermicularis(1.9%) and A
lumbricoides (0.2%) (Mawlood et al.,1998).
There is another epidemiological study in Hilla City made
by Al-Kubaiessy (2000) where investigated 4537 patients who
visited two hospitals ( Babil for childbirth and children hospital
and Marjan Specialist hospital ) and he found the total parasitic
infection was 47.1% including E coli (10.9%), E histolytica
(10.3%), G. lamblia(8.3%), T hominis (1.4%), Chilomastix
mesnili (0.9%), H nana(2.2%) , Taenia saginata (0.06%), E
vermicularis (10.4%) , Trichuris
trichiura (1.6%), A
lumbricoides (0.8%)and A duodenale (0.1%).
Materials and Methods
In period from May 2002 till February 2003 a surveillance study
was done at Al-Doullab village ( Hilla city rural) Babylon
province .( 681) Stool specimens collected in a clean, watertight container with a screw –cap lid.
Macroscopic examination of the samples was the first to
2
determine the consistency and color and the presence of blood
and mucus( Zeibig ,1997).
Second examination is microscopically by using direct
smear with normal saline (0.9%) and Lugol’s Iodine , by using
floatation method with saturated salt solution ( Zeibig ,1997).
Information list provided to each person to collect his name,
family number, drinking water, presence of animals and Watercloset in the house.
Chi square test (Campbell, 1967) were employed for the
statistical analysis.
Results
The total infection is 62.7 %, the total tested samples is 681and
infected samples is 427(table 1). Table (2) show the total
infected percent according to parasites among population. The
participated intestinal parasitic infection types were listed in
table (3). Table (4) illustrated the relationship between intestinal
parasitic infection and tested person’s age. Significant
differences between the infected number and age.
In table (5) there are significant differences between the infected
number and family number, the higher infection percent (77.6%)
when family number more than 13 and the low infection percent
(47.0%) in family number between (3-4).
Table (6) showed the relationship between intestinal parasitic
infection and drinking water used in houses, the infection
percent increased (81.3%) when using River water. Significant
differences were detected in statistical analysis.
The infection percent increased (73.0%) when the Water-closet
absent and no hand washing after excrement while decreased
(50.6%) in presence of Water-closet and hand washing after use
it, we have Significant differences in statistical analysis (table
7). Table (8) reveal the relationship between intestinal parasitic
infection and presence or absence of animals in houses,
infection percent (66.3%) increased with presence of animals in
the houses and decreased (31.4%) in absent it. Significant
differences between the infection percent and animals present.
3
Table (1): The numbers of infected and tested persons and
intestinal parasites percentage in at Al-Doullab village .
Region
Al-Doullab village
Tested
number
681
Infected
number
427
Infection
percentage %
62.7
Table (2): The total infected percent according to parasites
among population at Al-Doullab village.
Parasite
Entamoeba coli
Entamoeba histolytica
Iodamoeba butschlii
Giardia lamblia
Trichomonas hominis
Blastocystis hominis
Isospora belli
Hymenolepis nana
Enterobius vermicularis
Ascaris lumbricoides
Ancylostoma duodenale
Summation
Infected number
72
69
61
49
20
28
6
52
41
19
10
Infection percentage %
10.5
10.1
8.9
7.2
2.9
4.1
0.8
7.6
6.0
2.8
1.5
427
62.7
Table (3): The participated intestinal parasitic infection type
at Al-Doullab village.
Infection type
Single infection
Double infection
Multiple infection
Summation
Infected number
Infection percentage %
175
143
109
427
25.7
21.0
16.0
62.7
4
Table (4): The relationship between intestinal parasitic
infection and tested persons age at Al-Doullab village.
Age (year)
Tested number
Infected number
Infection percentage %
94
98
105
118
100
79
87
681
65
74
66
78
59
46
39
427
69.1
75.5
62.9
66.1
59.0
58.2
44.8
62.7
1-5
6-10
11-15
16-20
21-25
26-30
More than 30
Summation
Calculated χ2
22.28 *
12.59
2
Tabulated χ ( 0.01 )
* Significant differences (P≤ 0.05).
Table (5): The relationship between intestinal parasitic
infection and family number at Al-Doullab village.
Family
number
3-4
5-6
7-8
9-10
11-12
More than 13
Summation
Tested
number
66
85
111
168
175
76
681
Infected
number
31
46
63
104
124
59
427
Calculated χ2
Infection
percentage %
47.0
54.1
56.7
61.9
70.9
77.6
62.7
23.61 *
15.09
2
Tabulated χ ( 0.01 )
* Significant differences (P≤ 0.05).
5
Table (6): The relationship between intestinal parasitic
infection and drinking water used in houses at Al-Doullab
village.
Drinking
water type
Tap water
River water
Tap + River
Summation
Tested
number
Total number
Infected
number
Infection
percentage %
201
262
218
681
63
213
151
427
31.3
81.3
69.3
62.7
Calculated χ2
127.27 *
9.21
Tabulated χ 2 ( 0.01 )
* Significant differences (P≤ 0.05).
Table (7): The relationship between intestinal parasitic
infection and presence or absence of Water-closet in houses
and hand washing or not after using Water-closet at AlDoullab village.
Present of water-closet
in houses and hand
washing after using it or
not.
Present of water-closet
and hand washing after
using it.
Absent of water-closet and
no hand washing after
defecating.
Summation
Total number
Tested
number
Infected
number
Infection
percentage %
314
159
50.6
367
268
73.0
681
427
62.7
2
Calculated χ
Tabulated χ 2 ( 0.01 )
* Significant differences (P≤ 0.05).
6
36.26 *
6.63
Table (8): The relationship between intestinal parasitic
infection and presence or absence of animals in houses at AlDoullab village.
Animals
presence
Animals
present
Animals
absent
Summation
Tested
number
Total number
Infected
number
Infection
percentage %
611
405
66.3
70
22
31.4
681
427
62.7
2
Calculated χ
Tabulated χ 2 ( 0.01 )
* Significant differences (P≤ 0.05).
7
32.62 *
6.63
Discussion
The results showed the total infection with intestinal
parasites (62.7%) is high (table 1) because There are many
people in rural areas who suffering from parasitic infections due
to poor sanitation, poor public health practices, increasing of
vectors and malnutrition states in addition to using of river water
directly for drinking and washing. In addition to the affect of the
economic blockage in Iraq for long period leading to decreasing
of drugs and sanitation.
E. coli, I. butchlii, T. hominis are considered nonpathogenic parasites in human , they worldwide distribution and
their cysts contaminate food and drinking water then infect
human . Detection of these non-pathogenic parasites in human
would suggest ingestion of contaminated water or food and may
indicate possible exposure to pathogenic organisms (Schmidt &
Roberts, 1989; Garcia & Bruckner, 1993; Yilmaz et al., 1999;
Chin, 2000).
Infection with E. histolytica (10.1%) and G. lamblia
(7.2%) regard as critical infection and worldwide distribution
their cysts transmitted through contaminated food and water,
hand to mouth contamination. Flies and cockroaches serve as
vector for E. histolytica infection (Zeibig ,1997). Both E.
histolytica and G. lamblia cysts are resistant to chemical
disinfectant such chlorine. G. lamblia infection mainly
responsible for diarrhea especially in children rather than adults
(Zeibig ,1997; Tsuyuoka et al., 1999 ) .
B. hominis infection (4.1%) is initiated by ingestion of
fecally contaminated food or water . It causes diarrhea,
abdominal pain and fever (Zeibig, 1997).
I. belli infection (0.8%) is worldwide distribution parasite
transmitted by oocyst contaminated food or water .it’s infection
characterized by diarrhea, abdominal pain and eosinophilia
(Zeibig, 1997).
The infection with H. nana (7.6%) occurs by the presence of
rodent or beetles (Tribolium) in houses. These worms have
different life cycle, it can infect human with or without
intermediate host (Schmidt & Roberts, 1989).
8
E. vermicularis (6.0%) one of the famous children worms
infections especially in crowded areas such as schools and
orphans . It distributed all over the world (Prince, 1998).
The infection with A. lumbricoides (2.8%) is very
common in the world. It increased in poor sanitation regions,
particularly where human feces is used as a fertilizer and where
children defecate directly on the ground (Zeibig, 1997).
Ancylostoma duodenale infection (1.5%) is worldwide
distribution particularly in the inhabitants practice poor
sanitation practices, especially with regard to proper fecal
treatment and disposal. It infect persons who walk barefoot in
feces contaminated soil ( Al-Mamouri, 2000 ) .
It is clear from the table (3) that double infection is
(21.0%) and multiple infection is (16.0%) because of the highly
exposure to the infection sources such as contaminated food or
water (Al-Mamouri, 2000).
In small ages (1-5) and (6-10) infection was (69.1%) and
(75.5%), alternatively (table 4) due to the high chances for
infection in these ages and they not realize the good sanitation in
compare with older ages with significant differences (Abass,
1997; Al-Mamouri, 2000).
Also when the family number is high (more than 13)
(table 5) the infection is increased (77.6%) in compare with
family number (3-4) it’s infection percent (47.0%) because of
the crowding in houses leading to participation in food tools,
clothes and bed finally increasing the infection significantly
(Al- Omar, 1992).
In table (6) using of river water for drinking causes
increasing of infection significantly (81.3%) due to presence of
infective stages in this water from the fecal materials
contamination (Al-Mamouri, 2000).
One of the important reasons of increase infection is the
absence of water-closet in houses and no hand washing after
defecation, table (7) showed high infection (73.0%) due to
above reason. So the defecate directly on the ground give a
chance for flies and other insects to carry the infective stages
then contaminate the water or food. In addition to contaminate
9
the hands with fecal materials serve as hand to mouth
contamination. The statistical analysis reveal significant
differences (Abdel Messih et al., 1975 ;Al – Kafaji , 1999 ).
Finally presence of animals in houses plays a role in
transmission of infection as shown in table (8) it record infection
(66.3%) in the presence of animals. These animals ( rodents,
cats , dogs , cows , birds and others ) carry the infective stages
especially rodent regard as intermediate host for example dwarf
tape worm (H. nana) there is significant differences (AlMamouri, 2000 ; Wajihullah,2001).
From these study we conclusion the followings:
1- The total incidence of intestinal parasites infection in this
study was 62.7 % .
2- Entamoeba coli infection (10.5%) was the highest in
current study.
3- The infection increased with increasing of family number.
4- The infection with Isospora belli (0.8%) and Blastocystis
hominis (4.1%) were firstly recorded in Hilla city.
5- The using of river water facilitate the infection
transmission and increase it (81.3 %) .
So from above conclusion we recommend the increasing of
good personal hygiene and proper sanitation practice in addition
to water treatment before drinking (boiling or treating with
iodine crystals). Avoiding the use of human feces as fertilizer.
Finally protection of food from flies and cockroaches.
References
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11
‫‪‬‬
‫‪‬‬
‫‪ ‬‬
‫ﻜﻠﻴﺔ ﻁﺏ ﺍﻷﺴﻨﺎﻥ‪ -‬ﺠﺎﻤﻌﺔ ﺒﺎﺒل‬
‫اﻟﺨﻼﺻـﺔ‬
‫ﺘﻡ ﺇﺠﺭﺍﺀ ﺩﺭﺍﺴﺔ ﻭﺒﺎﺌﻴﺔ ﻟﻠﻤﺩﺓ ﻤﻥ ﺸﻬﺭ ﺍﻴﺎﺭ ‪ 2002‬ﻭﻟﻐﺎﻴـﺔ ﺸـﻬﺭ ﺸـﺒﺎﻁ‬
‫‪ 2003‬ﻟﻠﺘﺤﺭﻱ ﻋﻥ ﺍﻨﺘﺸﺎﺭ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﺍﻟﻤﻌﻭﻴﺔ ﻟﺩﻯ ﺴﻜﺎﻥ ﻗﺭﻴﺔ ﺍﻟﺩﻭﻻﺏ ) ﺃﻁـﺭﺍﻑ‬
‫ﻤﺩﻴﻨﺔ ﺍﻟﺤﻠﺔ ( ﻤﺤﺎﻓﻅﺔ ﺒﺎﺒل ‪ .‬ﺇﺫ ﺒﻠﻎ ﺍﻟﻌﺩﺩ ﺍﻟﻜﻠﻲ ﻟﻌﻴﻨﺎﺕ ﺍﻟﺒﺭﺍﺯ ﺍﻟﻤﻔﺤﻭﺼﺔ ‪ 681‬ﻤﻥ‬
‫ﻤﺨﺘﻠﻑ ﺍﻷﻋﻤﺎﺭ ﻭﺘﻡ ﺘﺴﺠﻴل ﺍﻟﻌﺩﻴﺩ ﻤﻥ ﺍﻟﻁﻔﻴﻠﻴﺎﺕ ﻤﻨﻬـﺎ )ﺍﻤﻴﺒـﺎ ﺍﻟﻘﻭﻟـﻭﻥ ﺒﻨﺴـﺒﺔ‬
‫‪ %10.5‬ﻭﺍﻤﻴﺒﺎ ﺍﻟﺯﺤﺎﺭ ﺒﻨﺴﺒﺔ ‪ %10.1‬ﻭﺍﻤﻴﺒﺎ ﺍﻟﻴـﻭﺩ ﺒﻨﺴـﺒﺔ ‪ %8.9‬ﻭﺍﻟﺠﻴﺎﺭﺩﻴـﺎ‬
‫ﺍﻟﻼﻤﺒﻴﻠﻴﺔ ﺒﻨﺴﺒﺔ ‪ %7.2‬ﻭﺍﻟﻤﺸﻌﺭﺓ ﺍﻟﺒﺸﺭﻴﺔ ﺒﻨﺴﺒﺔ ‪ %2.9‬ﻭﺍﻻﺭﻭﻤﺔ ﺍﻟﺒﺸﺭﻴﺔ ﺒﻨﺴـﺒﺔ‬
‫‪ %4.1‬ﻭﺍﻻﻴﺯﻭﺴﺒﻭﺭﺍ ﺒﻴﻠﻲ ﺒﻨﺴﺒﺔ ‪ %0.8‬ﻭﺍﻟﺩﻭﺩﺓ ﺍﻟﺸﺭﻴﻁﻴﺔ ﺍﻟﻘﺯﻤﺔ ﺒﻨﺴـﺒﺔ ‪%7.6‬‬
‫ﻭﺍﻟﺩﻭﺩﺓ ﺍﻟﺩﺒﻭﺴﻴﺔ ﺒﻨﺴﺒﺔ ‪ %6.0‬ﻭﺍﻟﺼﻔﺭ ﺍﻟﺨﺭﺍﻁﻴﻨﻲ ﺒﻨﺴﺒﺔ ‪ %2.8‬ﻭﺍﻟﺩﻭﺩﺓ ﺍﻟﺸﺼﻴﺔ‬
‫ﺒﻨﺴﺒﺔ ‪ .(%1.5‬ﻭﺒﻠﻐﺕ ﻨﺴﺒﺔ ﺍﻹﺼﺎﺒﺔ ﺍﻟﻜﻠﻴﺔ ﺒﺎﻟﻁﻔﻴﻠﻴﺎﺕ ﺍﻟﻤﻌﻭﻴﺔ ﻓﻲ ﻫﺫﻩ ﺍﻟﺩﺭﺍﺴـﺔ‬
‫‪.%62.7‬‬
‫‪12‬‬